NATIONAL CHURCH CONFERENCE OF THE BLIND

BENEVOLENCE FUND CRITERIA

N.C.C.B. BOARD TO DETERMINE ELIGIBILITY

IF YOU ARE APPROVED, YOU ARE EXPECTED TO ATTEND ALL NCCB MEETINGS, UNLESS YOU’RE ILL.

Please Complete Form

NAME:________________________________________________________

ADDRESS:____________________________________________________

CITY:_____________________ STATE: _____   ZIP CODE: ________

PHONE: (___) _________________________________________________

EMAIL ADDRESS: ____________________________________________

NOTE: A ROOMMATE WILL BE APPOINTED, TWO IN ROOM.

NET YEARLY INCOME (please circle one):

$5,000 to $10,000

$10,000 to $15,000

$15,000 to $20,000

$20,000 and up

 

UNEXPECTED HARDSHIP OR FINANCIAL STRAIN DURING THE PAST YEAR: (please explain)

MEDICAL:______________________________________________________

FAMILY:________________________________________________________

OTHER:_________________________________________________________

__________________________________________________________________

 

 IS THE ABOVE LISTED FINANCIAL HARDSHIP TEMPORARY OR ONGOING? (circle one)

Please explain: ________________________________________________________

_________________________________________________________________________

 

NUMBER OF DEPENDENTS IN YOUR HOME:  # ______

NAMES:_________________________________________________________

AGES:___________________________________________________________

 

PLEASE EXPLAIN WHAT YOU HOPE TO GAIN BY ATTENDING THE CONFERENCE:

 _____________________________________________________________________________

_____________________________________________________________________________ 

 

PLEASE EXPLAIN WHAT YOU FEEL YOU COULD CONTRIBUTE TO THE CONFERENCE:

Giving Devotions: ____________________________________________

Reading Scripture: ___________________________________________

Song Leader: _________________________________________________

Choir Member: _______________________________________________

Sighted or partially sighted Guide: __________________

Other:________________________________________________________________

_______________________________________________________________________

 

OUTSIDE HELP WITH FINANCING: (please explain)

FAMILY:_________________________________________________________

CHURCH:_______________________________________________________

FRIENDS:_______________________________________________________

OTHER:_________________________________________________________

__________________________________________________________________

 

ADDITIONAL COMMENTS: ___________________________________________

________________________________________________________________________

________________________________________________________________________

MAIL FORM TO:

THE NCCB

P.O. BOX 276

EDMOND, OK  73083